藥物終止妊娠後持續出血之中醫治療病例報告

目的：使用芎歸膠艾湯合柴胡龍骨牡蠣湯加減治療妊娠後持續出血。病例報告：45歲女性，月經45日未行，婦產科超音波檢查發現子宮內妊娠囊，欲使用藥物終止妊娠，服藥2日後開始有經血排出，量多，淋漓不止，皮膚紅疹，倦怠，因出血症狀持續2週，未有明顯改善而求診中醫。病人證型為衝任不固、肝鬱脾虛。治則以養血止血，泄熱安神。處方為芎歸膠艾湯合柴胡龍骨牡蠣湯加減。治療一週，淋漓與皮膚紅疹情形改善，治療1個月餘，經血淋漓明顯改善，但月經週期仍不規律，且經期長達10日，再以柴胡龍骨牡蠣湯加減合精氣神源治療1個月，經期減為5－6日，無經血淋漓。結論：辨證並調整處方持續治療3個月，月經週期趨於規律。本病例之治療成果可供中醫治療此類病症之參考。

關鍵字

Mifepristone ；持續出血；中醫；芎歸膠艾湯；柴胡龍骨牡蠣湯

並列摘要

A 45-year-old woman, whose menstrual cycle did not come for 45 days, visited gynecologist. Gynecologic ultrasound examination revealed intrauterine gestational sac. Mifepristone and misoprostol were used for termination of pregnancy. Heavy bleeding began after 2 days. She had blood dripping, skin rash, and fatigue without significant improvement after two weeks. She asked traditional Chinese gynecology medicine for help. Moderate obesity, stress from work, easy to get nervous, stiff neck and shoulders, dry mouth, poor circulation, leg swelling sometimes, inhibited defecation, breast fullnes, pink tongue, white and greasy coating, red tongue tip, floating and slippery pulse. These were caused by debility of Chong and Ren channels, stagnation of liver Qi and spleen deficiency. Chong and Ren channels became damaged after abortion. The Qi failed to control blood leading to bleeding. Emotional frustration led to stagnation of liver Qi and transforming into fire. The therapeutic principle were nourishing the blood, stopping bleeding, expelling the pathogenic heat, and tranquilization. The prescription is mainly based on Chiong Guei Jiau Ay Tang and Chaihu Jia Longgu Muli Tang. Symptoms were improved after 1 week of treatment. Ergometrine was also menstrual cycle. Duration became 5-6 days after treating with Chaihu Jia Longgu Muli Tang and Gui Lu Er Xian Jiao for 1 month. The menstrual cycle became regular after symptomatic treatment for 3 months. We hope the above information is helpful to the TCM doctors.

並列關鍵字

Mifepristone ； Continued bleeding ； Traditional Chinese Medicine ； Xiong gui jiao-ai tang ； Chaihu Jia Longgu Muli Tang

參考文獻

陳立德：中醫婦科學，弘祥出版社，台中，2003：114。

Google Scholar

Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with mifepristone and misoprostol in the United States. New Engl J Med 1998; 338: 1241-1247.